Neuro-Ophthalmology

Abstract

Neuro-Ophthalmology helps clinicians evaluate and manage patients with neuro-ophthalmic problems, and is divided into five sections: afferent (visual) disorders; efferent (eye movement) disorders; eyelid disorders; pupil disorders; and combination syndromes. It is based on the most current scholarly evidence and is filled with practical advice.

Avoiding Clinical Misinterpretation and Artifacts of Optical Coherence Tomography Analysis of the Optic Nerve, Retinal Nerve Fiber Layer, and Ganglion Cell Layer

“…Subjects who are born with large neural canals (large discs, including megalopapilla) and small neural canals (small discs, including optic nerve hypoplasia) that are outside the normative range may cause inaccurate designation of an abnormal cup. For example, a small optic nerve will appear congested and have nasal elevation of the disc, often referred to as a “little red disc,” and can be mistaken for disc edema ( 59 ). OCT analysis of the nerve demonstrating a small disc diameter with a normal RNFL thickness can help differentiate pseudopapilledema from true papilledema (Fig.…”

Papilloedema secondary to oligodendroglioma

“…In slow‐growing tumours, the flow of cerebrospinal fluid is blocked enough to cause increased ICP in those lesions that are posterior and/or extremely large . Patients with papilloedema and macular oedema can have reduced vision from the pathology, while those with choroidal folds or posterior globe flattening can have reduced vision from changes in refractive error …”

“…The abducens nerve is the most common cranial nerve affected by increased ICP due to numerous vulnerable compression areas along its long course through the cerebrum . Papilloedema, bilateral disc oedema secondary to increased ICP, is characterised by RNFL oedema, which gives the RNFL an opaque appearance that obscures the underlying retinal vessels and produces a halo around the disc . Optic disc oedema can progress to optic atrophy and RNFL defects .…”

“…Papilloedema, bilateral disc oedema secondary to increased ICP, is characterised by RNFL oedema, which gives the RNFL an opaque appearance that obscures the underlying retinal vessels and produces a halo around the disc . Optic disc oedema can progress to optic atrophy and RNFL defects . Papilloedema can also lead to macular oedema, as a result of optic disc leakage of water, protein and other axoplasmic contents into the extracellular spaces of the prelaminar portion of the optic nerve .…”

“…Temporal lobe lesions usually manifest with contra‐lateral upper quadrantopic visual field defects, while parietal lobe lesions show contra‐lateral lower quadrantopic visual field defects. Those patients with oligodendroglioma and papilloedema can manifest various other visual field defects, some being progressive and irreversible . One of the earliest visual field defects to present in a patient with papilloedema is an enlarged blind spot .…”